UB expert: Hawaii’s new cigarette law may be only part of the solution

Lynn Kozlowski writes that states should adopt differential age limits based on product risk

“Lumping all tobacco and nicotine products in the same standard ignores the considerable differences in harm to users or bystanders caused by different products.”

Lynn Kozlowski, professor of community health and health behavior

University at Buffalo

Lynn Kozlowski, PhD, professor of community health and health behavior.

BUFFALO, N.Y. – Hawaii has made headlines by becoming the
first U.S. state to raise the minimum legal age to buy cigarettes
and other tobacco products and electronic cigarettes to 21 from
18.

Such a move was encouraged by a review done by the National
Academy of Sciences’ Institute of Medicine. The move has
largely been lauded as a major step toward reducing cigarette
smoking, and the myriad negative effects it has on public
health.

But in a newly
published article, a University at Buffalo tobacco expert
argues that Hawaii’s decision is only one part of the
solution, and that the new law incorrectly lumps e-cigarettes and
lower-risk smokeless tobacco products (Swedish snus) in with the
much more harmful nicotine cigarettes.

“Lumping all tobacco and nicotine products in the same
standard ignores the considerable differences in harm to users or
bystanders caused by different products,” Lynn Kozlowski,
professor of community health and health behavior in UB’s
School of Public Health and Health Professions, writes in Issues in
Science and Technology, a quarterly publication that provides
experts in science, engineering and medicine with a platform to
share their perspectives with policy makers and the public.

“The precautionary bias that treats all tobacco products
the same obscures an opportunity to reduce the most dangerous form
of tobacco use and its costs to society — costs that are
increasingly borne by those who are already unhealthy, uneducated
and poor,” Kozlowski writes. The article, titled “A
Policy Experiment is Worth a Million Lives,” appears in the
winter 2016 edition of the publication, which is out now, and is
also online.

Kozlowski, an internationally renowned expert on tobacco use who
has more than 40 years of experience in researching the drug,
argues that policy experiments could lead to encouragement of less
harmful products, such as e-cigarettes and Swedish snus, as
substitutes for the more hazardous products like nicotine
cigarettes, which kill half a million Americans each year.

He writes that states should take advantage of the flexibility
they have to adopt different legal purchasing ages. “Such
quasi-experiments, in fact, proved valuable for alcohol regulation,
where the de facto standard legal drinking age of 21 was arrived
at, in part, by comparing the experience of different state age
limits,” Kozlowski writes.

Kozlowski suggests that 18 could be the legal age to buy less
harmful products like e-cigarettes and snus, while the legal age
for cigarettes could be higher, anywhere from 19 to 21. “The
need is to try to determine the benefits of pushing the age for
cigarettes above that for products that are much less
dangerous,” he writes.

If some states used this standard, it would help answer several
important questions, such as:

Would there be an overall decline in smoking?

Would smoking-related health problems in states that allow
people to purchase less harmful tobacco products at an earlier age
decline compared to states that regulate all tobacco products
uniformly?

“We can’t know the answer to these questions until
we do the experiment,” Kozlowski writes, “but if we
fail to do the experiment we miss the opportunity for potentially
major public health benefits.”

And, he adds, if troubling trends began to emerge in states with
differential age limits, the mistake could easily be fixed by
moving the legal age for the less harmful products up to that of
cigarettes. On the other hand, if the results are positive, other
states could adopt differential age limits, too.

Kozlowski previously worked at the Addiction Research Foundation
in Toronto, where he led the behavioral research program on tobacco
use. He came to UB in 2006 and served as dean of the School of
Public Health and Health Professions from 2008 until 2014, when he
resumed his role as professor. Kozlowski has published articles on
e-cigarettes in several media outlets, including The
Huffington Post and The
Conversation.

He has also published articles on tobacco policy perspectives in
Science, JAMA, American Journal of Preventive Medicine, Tobacco
Control, Addiction and other leading scientific journals.